1. General treatment: Choose appropriate cleansing products in the morning and evening to remove excess oil, dandruff and bacterial mixture on the skin surface, but don't wash too much, and pay attention to oil control and moisturizing. Avoid squeezing skin lesions by hand. Appropriately limit the intake of high glycemic index food and milk that may induce or aggravate acne, keep the stool unobstructed, work and rest regularly, and avoid staying up late.
2. External drugs.
(1) tretinoin: local irritation reactions such as erythema, desquamation, tightness, burning sensation will occur when using it for the first time, so it should be tried in a low concentration or in a small range, and it is required to avoid light. It is recommended to use it before going to bed.
(2) benzoyl peroxide: it has the functions of killing propionibacterium sores, dissolving acne and astringing, and can be made into lotions, emulsions or gels with different concentrations. A small number of patients will have mild skin irritation, so it is recommended to start with low concentration and small range.
(3) Antibiotics: fusidic acid cream, erythromycin ointment, lincomycin, clindamycin, chloramphenicol and other external preparations.
(4) Azelaic acid: It has therapeutic effect on inflammation and acne, and can also reduce post-inflammatory pigmentation. Can be made into 15% ~ 20% cream for external use. The adverse reactions were local mild erythema and tingling.
(5) Selenium disulfide: 2.5% disulfide tanning lotion can inhibit fungi, parasites and bacteria and reduce the content of free fatty acids in skin.
(6) Other drugs: 5% ~ 10% sulfur lotion, 5% ~ 10% salicylic acid cream or gel have the functions of inhibiting Propionibacterium acnes, peeling slightly and resisting bacteria.
3. Systematic drug therapy
(1) Oral antibiotics: tetracyclines (minocycline, doxycycline, etc. ) is the first choice, followed by macrolides (erythromycin). Avoid choosing antibiotics commonly used to treat systemic infections, such as levofloxacin. The course of antibiotic treatment is usually 6 ~ 12 weeks.
(2) Oral isotretinoin: For severe acne, oral isotretinoin is the standard therapy and the most effective method to treat acne at present. The goal of the course of treatment is to achieve the lowest cumulative dose of 60 mg/kg.
(3) Antiandrogen drugs: such as oral contraceptive compound cyproterone acetate tablets, which are suitable for female patients with moderate and severe acne, accompanied by high androgen level (such as hirsutism and seborrhea) or polycystic ovary syndrome. Female patients with acne and acne before menstruation can also consider using oral contraceptives.
(4) Oral glucocorticoid: mainly used for fulminant or polymeric acne, following the principle of short-term, low-dose and combined application with other methods.
4. Other treatments
Physical therapy, such as PDT, fruit acid therapy and laser therapy, can also be considered for patients who are intolerant or unwilling to accept drug treatment.